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THE JOHNS HOPKINS ACG® SYSTEM

For more than 30 years, the Johns Hopkins ACG® System has been used across the world to support population health management, enhance care and reduce health care related costs. Its logic is based on the premise that clustering of morbidity is a better predictor of the use of health care services than the presence of specific diseases or prior levels of cost or activity.

The ACG System in the NHS

The ACG System has been used extensively within the NHS since 2009. Over 11 million patient records are processed through the ACG System to support the work of:

40+ Clinical Commissioning Groups (CCGs)

7 Sustainability and Transformation Partnerships (STPs)

3 Accountable Care Systems (ACS)

1000+ GP Practices

Uses and benefits of the ACG System in the UK

In the UK, the ACG System is being used to support a wide range of activities, including:

Reducing emergency care costs – three CCGs have now commissioned primary care-based, multi-morbidity clinics which have seen an associated 19% decrease in emergency admissions in the 18 months after the scheme started.

Population health analytics and population profiling to support planning and commissioning activities by CCGs and transformational change by STPs and ACSs

Sophisticated case finding activities by GP Practices and community services to ensure that the right patients are matched to the right care programmes

Casemix adjusted benchmarking and actuarial based analyses to allow for the differences in morbidity burden of patients that exist between different GP practices and localities, when measuring performance to identify good practice and opportunities for improvement

Allocation of resources using a more equitable approach based on differences in casemix and the predicted needs of individuals and population

More information about each of these aspects, case studies and the benefits being achieved can be found by clicking on the below buttons.

The ACG System’s origins are in the Johns Hopkins University Bloomberg School of Public Health but it is now used in nearly 20 counties around the world. The ACG System has been fully adapted and calibrated to work with NHS data and models of care delivery in the following ways:

Integrates data from both primary and secondary care so that analyses and predictions can be done for the whole population, not just the 20% who have a hospital episode

It recognises and can use the main diagnostic and pharmacy code sets used within the NHS including ICD10, SNOMED CT and Read Codes.

The mapping tables related to these code sets are updated every three months as new codes are introduced

There have been two recalibrations of the predictive models, one in 2013 and one in 2016. Another is planned for 2018/19

Development of new predictive models based on emerging priorities and new NHS related policy

ACG System UK Team

The ACG System Team helps organizations throughout the world use their available health information to:

Measure the health care needs of their population

Provide equitable distribution and remuneration of services, and

Identify ways to improve the efficiency of the delivery of care.

The ACG System’s primary objective is the improved health status of a population. In keeping with this mission, the Team supports ACG System users worldwide to ensure the correct installation, implementation and interpretation of the software and its output. The Team also assists users in the customization of the ACG System to local contexts.

In the UK, the large and growing ACG System user community is currently supported by a subset of this team. Each member of the UK team has worked within the NHS as well as having been involved in relevant work at a national and international level.

Alan Thompson, MSc; Director of User Support; UK Team Leader

Mr. Thompson joined the ACG System Team in 2013. As Director of User Support, Alan’s primary responsibilities include supporting users, collaborators, and team members in maximizing the use of the ACG System. He also coordinates the UK Team in facilitating applications of the ACG System in the UK NHS.

A registered nurse by background, Mr. Thompson has over 30 years’ experience in the UK National Health Service (NHS) in clinical, operational and project management posts within hospitals and primary care. He has a keen interest in the use of information to support managerial and clinical decision-making and to inform improvements in the provision of patient-centered services.

Between 2010 and 2013, Mr. Thompson led a project to implement the ACG System across 600 GP Practices in the south of England. This role supported clinicians in optimizing the use of risk stratification information to inform clinical programs such as case management and integrated care teams. He also worked with Clinical Commissioning Groups (CCGs) to use risk stratification to support commissioning activities.

As a firm believer in sharing experience and expertise across the NHS, he established both the Southern England and national UK ACG System User groups to facilitate conversations and shared learning among NHS users of the ACG System.

James Barrett, MA, MB, BChir, MSc; Senior Analyst, UK

Dr. Barrett has been with the ACG System Team since 2009. He provides technical support to ACG System users within the NHS. He worked for 20 years in health care informatics and has a particular interest in OLAP and web-based analytical tools. He has medical qualifications and is interested in all aspects of the application of information technology in health care. He was a member of the SNOMED CT Technical Design team and has extensive experience working with the Read Code authoring project. Joining the NHS Information Authority in 1999, he worked on reporting tools to provide interactive access to HES data for NHS users. More recently he has worked for a number of years with PRIMIS+ analyzing data quality in primary care, and for the National Diabetes Audit at the NHS Information Centre analyzing the care given to patients with diabetes.

Dr. Barrett received his MA from Cambridge University.

Steve Sutch, MAppSc, BSc, DrPH; Director of Product Development

Dr. Sutch has been working with the ACG System Team since 2007. He has over 20 years experience of working in the National Health Service (NHS) in Great Britain at local, regional and national levels. He has worked with data and data collections from various aspects of activity and financial returns. His lead role in the design of HRGv35, a tool currently used for hospital payments in NHS England– and its updated version HRGv4– led to the development of analytical methods on routinely collected NHS data as well as other clinical data collections. He has an extensive working and practical knowledge of the HES/NWCS/SUS data collections.

He also worked on benchmarking systems for commissioning in Great Britain to develop a national system of tools, first in NHS Wales and later in England. As the Analytical and Statistical Services Manager of the NHS Information Authority National, Dr. Sutch oversaw the continued development of national benchmarking products, and supported the initial development of the program budget categories. He also sat on the committees responsible for the implementation of ICD-10 codes in England and Wales, and then led the development of HRGs that formed a major contribution to the redevelopment of the surgical classification (OPCS4.3, 4.4).

Through the Kings Fund project, and subsequent projects with various PCTs, Dr. Sutch has gained expertise in the application of ACGs® to NHS ambulatory data.

ACG System UK Print Materials

There are over 40 CCGs and 1000 GP Practices in the UK who now use the Johns Hopkins ACG System to improve the health of their populations. Until recently, the vast majority of the use of the ACG System has been to support case finding activities within GP Practices. Over the last 12-18 months the use continued to expand and now covers case finding activities by community teams and significantly, population profiling activities to support the commissioning work of CCGs.

This page provides access to the growing number of case studies, articles and other written material that illustrates how NHS staff and organisations are using the ACG System to support individual patients and whole populations.

Please log in to access the following resources, specific to ACG System applications throughout the United Kingdom *access code not required:

Overviews:

Risk Stratification – An introduction to the basics: This document provides a high-level overview of what risk stratification is, its relevance to the health service and some things to consider when using risk stratification tools and methodologies. LEARN MORE

ACG System Predictive Models Overview: This document provides a high-level overview of how the predictive models within the Johns Hopkins Adjusted Clinical Groups (ACG) System are designed and the factors that are used to calculate risk of key adverse outcomes. LEARN MORE

Case Studies:

Population Segmentation Case Study: Government. Three CCGs analyzed their local populations to address the care of people who are frail. LEARN MORE

Working for Better Health in Wandsworth: Sollis was one of a number of partners Wandsworth CCG chose to help them implement the Planning All Care Together (PACT) initiative to change how patients with long-term conditions receive care. LEARN MORE

Warrington HealthPlus Case Study: Warrington HealthPlus GP consortium and CCG are modelling the care delivered to patients in care homes, to understand the impact of new initiatives they have commissioned in that area. LEARN MORE

White Paper:

Applications of the ACG System in the UK: Gives an overview of the ACG System and how it is being used to support a range of clinical and commissioning activities. LEARN MORE

Understanding Population Health: Explores issues, opportunities and a range of analytical approaches undertaken within the NHS. Provides examples of how the insights from integrated data sets and the analytical techniques are being used to inform clinical and commissioning decisions. LEARN MORE

Articles:

Identifying People at Increased Risk of Severe Illness from COVID-19 in the UK: Insights from the ACG System can identify vulnerable populations. LEARN MORE

Using case finding and risk stratification: A key service component for personalised care and support planning NHS-England. LEARN MORE

Predictive Models in the ACG System: Recalibration of Existing Models and Development of New Ones. LEARN MORE

Presentations:

The 2018 Leicester Symposium brought together ACG System users to explore different types of advanced population health analytics used to support the work of CCGs, STPs and ACSs. Attendees also discussed using casemix-adjusted data to undertake meaningful assessments of performance against key NHS targets. Access the presentations from the Symposium. LEARN MORE

The 6th Johns Hopkins London Symposium is a biennial conference bringing together people from the NHS and academia who are interested in risk stratification, population health profiling and case mix. The Symposium in 2014 was attended by over 100 people, the majority of whom worked within the UK health service. Attendees also included representatives from a number of European countries interested in the work of the ACG System in the UK. Access the presentations given at the 2011 Johns Hopkins London Symposium on Case Mix: “Risk Stratification to Support Integrated Care.” LEARN MORE

The 2015 Patient Classification Systems International (PCSI) conference: Towards Sustainable Health and Social Care Systems, focused on issues that top the health and social care agendas – case mix, health information, person-centered health care, value-based approaches, assessment and appropriate funding. The ACG System team participated in this event and won a prize in the best paper competition with Case Finding & Population Profiling – Separate Disciplines or Both Sides of the Same Coin? LEARN MORE

ACG System UK Webinars – Podcasts – Videos

Podcast:

Use of Johns Hopkins ACG System in the UK to Support Case Finding Similarities to the U.S. Health Care System. LEARN MORE

ACG System UK Frequently Asked Questions

What exactly is the ACG System?

The ACG System is a decision support system originating from the Johns Hopkins Bloomberg School of Public Health. The core of the system is based on the use of diagnosis information, combined with other information such as activity and cost, to provide intelligence at both patient-level (e.g. predicting a patient’s risk of needing lots of health care in the future) and population-level (e.g. describing or comparing the disease burden within or between populations).

So the ACG System is American?

The ACG System was certainly born in the USA 30 years ago and has grown and developed significantly over that time. However, over the last 10 years it has been adopted and adapted for use in the UK in a number of ways. It recognises all of the diagnostic and pharmacy Read codes that we use in primary care and each quarter any new Read codes are mapped to the appropriate group within the ACG System. In 2012 a major exercise was undertaken to recalibrate the predictive models within the ACG System – a three way collaboration between Johns Hopkins, NHS South, Central and West Commissioning Support Unit and Sollis. A new predictive model was also developed to calculate an individual’s risk of emergency admission. A repeat of this recalibration exercise is being undertaken at the end of 2015.

What are the benefits of using the ACG System?

The primary operational use of the ACG System to date in the UK is to support case finding activities, particularly in relation to the national objective of reducing the number of emergency admissions by early identification and intervention with high risk patients. However, the ACG System has multiple additional applications, and there are numerous examples within the UK of the ACG System being used to support:

Finding patients from all levels of the risk pyramid whose care would benefit from various services and care programmes

Population profiling to better understand the current and future health needs of the whole population and commission services accordingly

Resource management to enhance the way in which primary care providers perform relative to the morbidity profiles of their populations

Research around multi-morbidity, resource use and health outcomes

For specific examples and additional information, please review the available case studies, articles, podcast and more.

Who is using the ACG System in the UK?

There are over 40 CCGs and 1000 GP Practices in the UK who now use the Johns Hopkins ACG System covering a population of over 10 million.

So it’s just the US and the UK who use the ACG System then?

The ACG System is the most widely used population-based case mix system in the world. Since 2003, the ACG System team has seen its international reach expand from a single project in Canada to on-going use in several European, Asian, Middle Eastern, South American and African countries. In addition, numerous pilot and academic projects are underway across the globe. In summary, the ACG System is active on almost every continent.

How can I find out more?

Further details of the use of the ACG System in the United Kingdom can be obtained from Alan Thompson, Senior Consultant and UK Team Leader at athompson@HopkinsACG.org.

ACG System UK News

8th London Symposium to be held at Royal Society of Medicine. LEARN MORE

CCG praised for use of population health management software. LEARN MORE

You can now follow the Johns Hopkins ACG System UK Team on twitter. LEARN MORE

Arden & GEM CSU team won prestigious Health Business Award using the ACG System. LEARN MORE

United Kingdom :: Sollis

Sollis has been delivering business intelligence and health care analytics solutions to the UK National Health Service (NHS) since 1994.

We have a long and established relationship with the Johns Hopkins University where we have successfully integrated the ACG® System into our health care business intelligence software – Clarity Patients.

We believe that our collaboration with the world renowned Johns Hopkins University has resulted in one of the most advanced clinically based commissioning decision support systems available to the UK health care system.

Sollis Clarity Patients is the largest implementation of the Johns Hopkins ACG System in the UK.

Today, Clarity Patients combined with the ACG System processes records for approximately eight million patients, having been implemented in three large Commissioning Support Units (CSUs):

NHS South East CSU

NHS South, Central and West CSU

NHS North and East London CSU

It currently supports 30 Clinical Commissioning Groups (CCGs) and over 900 GP Practices.

In 2013, Sollis collaborated with the ACG System Team and NHS South, Central and West Commissioning Support Unit to recalibrate the predictive models in Version 10i of the ACG System to better reflect the NHS context. This enables the ACG System to more accurately capture the morbidity patterns within the NHS as well as the factors that contribute to increased risk within the local population. NHS South, Central and West Commissioning Support Unit and Sollis agreed to make this enhancement available free of charge to other non-Sollis NHS implementations.

We continue to further develop Clarity Patients while integrating the ACG System to support service transformation and outcomes based commissioning for the UK NHS. Clarity is a key component of any population health management strategy and can help accountable care organisations transition from volume-based to value-based health care. Download our white paper here.

Find out how CCGs are using Clarity Patients and the ACG System to transform services. LEARN MORE

Access the Sollis Case Study on NHS South, Central and West Commissioning Support Unit’s ACG System implementation LEARN MORE

If you place the patient at the heart of all you do; if you want to work with people who will enable the systems, the data and the insights to help you deliver care appropriately and efficiently then we should be talking. We clearly share the same values. www.sollis.co.uk